Hospitals Admitted Patients They Should Have Sent Home

The chief financial officer at the Walton Regional Medical Center was fined for reporting what he believed was wrongdoing at the hospital. The CFO, Ralph D. Williams, hired a consultant to study admissions practices at the hospital and found that it was hospitalizing patients who should have been sent home. He took the report to his boss, who allegedly told him to “Burn it.” Williams was fired soon thereafter — and he believes his questions about admissions led to his dismissal.

Williams remembered what he saw at the hospital, and more than four years later he has emerged as a high-profile whistleblower. He is involved in a national case alleging widespread misconduct at Health Management Associates (HMA), one of the nation’s largest for-profit hospital chains. The U.S. Justice Department announced recently that it would intervene in eight federal whistleblower lawsuits against Health Management Associates, including a case filed by Williams in 2009.

While the allegations by Williams and other insiders are years old, they are only just now coming to light. The cases were filed under seal, and the whistleblowers have worked confidentially with the government. Federal authorities determined that the allegations had enough merit to warrant the Justice Department’s involvement in the case.

The government’s announcement that it was intervening in the cases came on the eve of a major corporate change for Florida-based HMA. In late January, the Tennessee-based hospital chain Community Health Systems acquired HMA, creating a system of 206 hospitals nationwide. The deal makes Community Health one of the nation’s largest hospital chains. The 71 HMA hospitals that are now part of the Community Health chain include three in Georgia: Barrow Regional in Winder, East Georgia Regional in Statesboro and Walton Regional in Monroe, which reopened in a new building as Clearview Regional in 2012. Community Health already operated two other Georgia hospitals: Trinity Hospital in Augusta and Fannin Regional in Blue Ridge.

The whistleblower lawsuits investigated by the Justice Department contend that HMA’s executives pressured doctors to admit patients who could have been placed in observation or treated as outpatients. The government says that resulted in HMA submitting inflated or even false bills to Medicare and Medicaid. The suits also allege that some hospitals paid kickbacks to physician groups staffing HMA emergency rooms to induce the doctors to admit patients.

Dr. Craig Brummer, who worked as a medical director at Barrow Regional and Walton Regional, also filed a whistleblower suit accusing the hospital of routinely pressuring doctors to admit patients. Brummer included profiles of patients who were improperly admitted. Among the cases:

A 71-year-old Medicare patient who came in to the ER complaining of neck pain but was admitted to the hospital for “a chest pain rule out.”

An infant covered by Medicaid who came in with a fever and was given a full workup of chest x-rays and lab work that came back normal. He was still admitted to the hospital even though his fever had dropped to 98.7.

An 18 year-old Medicaid patient with a knee laceration who was admitted to the hospital when the wound could have been repaired in the ER and the patient could have then been sent home.

Brummer said in his complaint that “HMA constantly re-emphasized the HMA corporate goal of admitting as many patients as possible regardless of whether the patients needed to be treated on an inpatient basis.” Marlan Wilbanks, an Atlanta lawyer, represents both Williams and Brummer in the cases. The two Georgia cases were the first to be filed of the eight cases that DOJ is now pursuing.

Williams didn’t stop with one hospital chain when he started blowing the whistle. Another whistleblower case filed by the former CEO accuses Tenet Healthcare Corp. of a scheme to defraud Medicaid. Williams claims that Tenet hospitals, including Atlanta Medical Center and North Fulton Hospital, were paying illegal kickbacks to a clinic to steer patients to its hospitals. The U.S. attorney for the Middle District of Georgia is seeking approval to intervene in the case. The Georgia attorney general’s office intervened in the case last year after conducting its own investigation.